Open access routes within endoscopic sinus surgery

Introduction:

The originally used open access to the paranasal sinuses loses more and more relevance in times of endoscopic sinus surgery due to its morbidity. The advancement of the endoscopes and navigation makes most areas of the sinuses and the rhinobasis accessible. In individual cases, however, it may be necessary to combine the endoscopic surgery with open procedures. We present case studies of combined sinus approaches.

Methods:

Various pathologies such as the inverted papilloma of the maxillary and frontal sinuses and meningoencephaloceles in the skull base are used to analyze the possibilities and limitations of the endoscopic and open access routes and a combination of both.

Results:

According to the current standard, inverted papillomas can be largely resected endonasally by endoscopy. However, if these are located in the frontal sinus or lateral maxillary sinus wall, as well as in the alveolar recess, the endoscope reaches its limits, requiring a combined access pathway from the endonasal and external sites. Also, meningoceles and smaller meningoencephalocels can often be resected endoscopically and the resulting defects covered. Due to decreasing stability from a certain size, endoscopic coverage of the endonasal area is not possible endoscopically, so that an openly combined access path should be selected.

Conclusion:

Despite the rapid development of endoscopes with different angles, this technique sometimes reaches its limits, so that even today the open access to the paranasal sinuses in combination with the endoscopy is justified.

Anna-Sophia Grossi

HNO Uniklinik Ulm,

Frauensteige 12, 89075

Ulm

Email: anna-sophia.groß[e-mail]

Publication History

Publication Date:
23 April 2019 (online)